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In fluoride's footsteps


Billed as the best thing for teeth since fluoride, a combination of calcium and phosphate is being added to a new line of drugstore products that hold the promise of fewer cavities.

The extra dose of calcium phosphate is finding its way into toothpastes and gums to encourage a process called remineralization. The technique, backed by preliminary research from the American Dental Association, strengthens tooth enamel and may prevent cavities or even allow teeth to repair themselves in the early stages of decay.

Studies have shown that remineralization can particularly benefit diabetics, kidney dialysis patients and people undergoing radiation treatment, as well as those taking high blood pressure medications, antidepressants, antihistamines and other drugs that reduce saliva flow and make people more vulnerable to cavities.

At least two products with remineralization ingredients already can be found in drugstores: a white, minty toothpaste called Enamelon and a new version of a sugarless gum called Trident Advantage.

But many other products are expected to hit the market within the next few years as studies of remineralization progress. Researchers predict these additives will appear in mouthwashes, lozenges, professional dental products and even beverages.

"This is just the beginning of what we're going to see a lot of in the future," says Frederick Eichmiller, director of the ADA Health Foundation's Paffenbarger Research Center, a Gaithersburg center that holds numerous remineralization patents. "Until now, fluoride has been the only tool we've had for active prevention."

Florida dentist Cesar Sabates brushes his teeth each night with Enamelon, which is manufactured by a small company of the same name based in New Jersey. But he has been reluctant to recommend it to patients because the white toothpaste has yet to earn the ADA's "seal of acceptance."

"Before I give something to patients, I want to try it myself," says Sabates, who buys his 4.4-ounce tube for $4.79. "I'm trying it on myself because I'm not 100 percent confident. But it's this type of preventative measure that is the wave of the future. We're the only profession trying to put itself out of business."

Remineralization research to date primarily consists of short-term studies showing that calcium phosphate additives can strengthen teeth. The research also suggests that extra doses of the minerals could reduce cavities in the long run.

Enamelon and other new remineralization products have not won the ADA's seal because that requires extensive long-term human research to prove safety and effectiveness.

"We just don't have the time yet," Eichmiller says. "That usually takes six to seven years and covers thousands of patients. It's very expensive to do. We're working on that, and probably many companies are attempting the same thing."

Meanwhile, dentists and researchers say, there is nothing harmful in current remineralization products.

Calcium and phosphate already exist naturally in teeth and saliva. A cavity starts when plaque on a tooth produces acid, which dissolves the calcium and phosphate. Every time a person eats, he or she loses small amounts of those minerals. The body can slowly restore these minerals to teeth on its own -- fluoride acts as a catalyst to quicken that effort -- but by adding extra doses of the minerals, it speeds up the process even further. If minerals aren't restored in time, a cavity can cause the tooth to collapse.

Research at the ADA's Gaithersburg center has shown that remineralization ingredients can heal a cavity in its beginning stages -- refuting earlier beliefs that decay is irreversible.

A recent study at Tufts University involving cancer patients undergoing radiation treatment found that Enamelon was seven times more effective than a standard fluoride toothpaste in reversing cavities.

Recaldent, a remineralization ingredient already patented, is now being used in Trident Advantage chewing gum. Dentists have touted the benefits of chewing sugar-free gum for years because it helps stimulate saliva production, bathing teeth in extra minerals. But five recent clinical studies show that the remineralization process can be sped up even more by Trident Advantage.

Because remineralization involves natural minerals, even holistic dentists have embraced these products on the market.

Dr. Steven H. Green, a Miami dentist who is president of the national Holistic Dental Association, tore out an advertisement for Trident Advantage he saw in a dental journal and suggested that his office order it for kids.

"Of course excessive gum chewing can hurt your jaw joints, but to chew gum for five to 10 minutes after a meal can be very beneficial," Green says.

The country's aging population stands to benefit most from remineralization, researchers says. Thanks to fluoride toothpaste, about 90 percent of today's children have few, if any, cavities, says the ADA's Eichmiller. But because people are living longer these days, they run the risk of suffering from more cavities as they age. Aging contributes to gum disease, gum recession and exposure of roots.

"If you looked at the last generation, more than half lost their teeth by the time they were 60," Eichmiller says. "Dentures were considered normal. But with the baby boom generation, that's not acceptable. These are the Crest kids who don't see losing their teeth as being the normal course. They're keeping their teeth longer and they want them to be healthy."

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